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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Dr. Bob on January 28, 2004, at 18:47:16
In reply to Buprenorphine herion withdraw side affects, posted by sbaartman on January 28, 2004, at 8:50:18
> Ok hope I get response gonna repost this since I did not get any response earlier, because I do not know what is happening to me. I was put on buprenorphine treatment for about the fourth time now. I have started to use again for about a month. but now when I try to return to the treatment I get severe nausea or more of a gal attack that does not seem to go away. I have tried to keep the hold as long as possible from my last heroin shot. And the last time was as much as 15 hours. Every time this happens I get so weak that I cannot even function probably after taking the bupe. WHAT IS HAPPENING?
Posted by Twainesworld on January 29, 2004, at 4:00:42
In reply to Buprenorphine side affects « sbaartman, posted by Dr. Bob on January 28, 2004, at 18:47:16
Hi SB-man,
Sorry to be dumb about this (in that I didn't check into it first, so I don't really know), but what you're describing almost sounds like what happens to alcoholics who try to drink when they are on Antabuse treatment!! Maybe the Buprenorphine contains something to MAKE you sick if you use H on TOP of it -- sort of like behavioral modification therapy or something!? Is Bupe a narcotic agonist? If not, and it's more like Methadone, then maybe the combination of Heroin and Buprenorphine is too much for your system & that's what is making you sick (almost like when some people do H for the first time & get sick)!!?
Sorry I'm not any help!!! Hopefully KBL (whom I think is a nurse) will know & will be able to post an answer for you!
Be careful with using until you find out for sure!!
Take Care of yourself..............
Posted by krazybirdlady on January 29, 2004, at 17:35:10
In reply to Buprenorphine side affects « sbaartman, posted by Dr. Bob on January 28, 2004, at 18:47:16
well, sounds like you are having withdrawl effects as you combined the 2 drugs too soon. buprenorphine is not to be mixed with any opiate that you may be dependant on as withdrawl can occur. please be careful...
Posted by Lindsay Rae on January 31, 2004, at 23:16:51
In reply to Re: Buprenorphine side affects, posted by Twainesworld on January 29, 2004, at 4:00:42
Buprenorphine is a partial agonist and is only available in the US as Suboxone, which contains a small amount of Naltrexone. Yes, you will feel sick if you try to get high or if you exceed the ceiling level of Bup (32 mg). It's a complicated drug, so I'll direct you to an expert:
Posted by MB on February 15, 2004, at 12:46:02
In reply to Buprenorphine side affects « sbaartman, posted by Dr. Bob on January 28, 2004, at 18:47:16
Buprenorphine is a partial agonist. Here's an analogy: think of the mu opiate receptor (the one that gets you high) as a door. Heroin, codeine, morphine, oxy, etc. are all *full* agonists. Think of them as holding the door ALL THE WAY open. This will make you feel good. OK, now think of the buprenorphine (the partial agonist) as forcing the door to the half-open position.
So...if you are currently using a full agonist, and the door is all the way open, and you introduce buprenorphine, that door is going to become halfway shut and you'll be thrown into withdrawal: instant cluck. Now, suppose you've quit the full agonist (heroin, oxy, etc.) and you're already sick. That means that door is slammed shut. At this point, adding buprenorphine will open that door half way and make you feel better.
Buprenorphine to a "well" addict = instant cluck.
Buprenorphine to a kicking addict = relief.
Buprenorphine to someone who has not been using = mild high.In treatment, I saw a patient come in who had fixed right before getting there. He was feeling quite well. The doc gave him a Subutex (sublingual buprenorphine) tab right away, and before it was halfway dissolved the guy puked all over the docs shoes. The damn bupe threw him into a cluck, but by the time the heroin was out of his system, he was sure glad he had the bupe: he felt fine. And for him, the bupe withdrawal was cake.
MB
Posted by MB on February 15, 2004, at 13:12:03
In reply to Re: Buprenorphine side affects, posted by Lindsay Rae on January 31, 2004, at 23:16:51
> Buprenorphine is a partial agonist and is only available in the US as Suboxone, which contains a small amount of Naltrexone.
Both Subutex and Suboxone are available in the US. Subutex (straight bupe) is recommended for initial, inpatient detox, while Suboxone is recommended for maintenance. Suboxone containes bupe + naloxone (Narcan), not naltrexone (Revia). When taken sublingually the effects of the Narcan are minimal, but if the tabs are crushed to be injected, the Narcan *is* effective, and will prevent the user from feeling the effects of the buprenorphine. So Suboxone is safer to use in an outpatient basis (less abuse potential). Don't forget that buprenorphine is also used as a painkiller. It is an injectable named Buprenex, and it IS NOT approved for use in detoxing addicts. Although, about ten years ago, a treatment center called Azure Acres in California gave me sublingual Buprenex (off lable) to detox me from heroin. I don't think the DEA would have had a problem with this, as back then, buprenorphine was only a C-V narcotic. It's now been moved up to a C-III narcotic. I guess that since it's been officially approved to treat addicts, the DEA wants tighter control. The schedule change was made THE SAME DAY that buprenorphine was approved to treat addicts. Not a coincidence.
MB
Try this link:
Posted by MB on February 15, 2004, at 13:15:02
In reply to Re: Buprenorphine side affects » Dr. Bob, posted by MB on February 15, 2004, at 12:46:02
Sorry Dr. Bob, didn't mean to imply that you needed an explaination re: buprenorphine. I was trying to help sbaartman.
MB
Posted by Lindsay Rae on February 16, 2004, at 17:06:07
In reply to Re: Buprenorphine side affects » Lindsay Rae, posted by MB on February 15, 2004, at 13:12:03
Thanks for the link; I'll pass it on to friends who have asked about Bup, and to my own counselor who swears that Bup and Subutex are different entities. But even in your link, it said Naltrexone in one paragraph and Naloxone in another, so which is it? Here's the quote:
"Buprenorphine is a partial opiate agonist: it blocks withdrawal and craving without producing a strong narcotic high. Naltrexone is an opiate antagonist that causes unpleasant side-effects for opiate users; it is added to prevent diversion and abuse because its effects are felt most acutely when the pills are crushed in order to be injected intraveneously."
Buprenorphine is a partial agonist and is only available in the US as Suboxone, which contains a small amount of Naltrexone.
>
> Both Subutex and Suboxone are available in the US. Subutex (straight bupe) is recommended for initial, inpatient detox, while Suboxone is recommended for maintenance. Suboxone containes bupe + naloxone (Narcan), not naltrexone (Revia). When taken sublingually the effects of the Narcan are minimal, but if the tabs are crushed to be injected, the Narcan *is* effective, and will prevent the user from feeling the effects of the buprenorphine. So Suboxone is safer to use in an outpatient basis (less abuse potential). Don't forget that buprenorphine is also used as a painkiller. It is an injectable named Buprenex, and it IS NOT approved for use in detoxing addicts. Although, about ten years ago, a treatment center called Azure Acres in California gave me sublingual Buprenex (off lable) to detox me from heroin. I don't think the DEA would have had a problem with this, as back then, buprenorphine was only a C-V narcotic. It's now been moved up to a C-III narcotic. I guess that since it's been officially approved to treat addicts, the DEA wants tighter control. The schedule change was made THE SAME DAY that buprenorphine was approved to treat addicts. Not a coincidence.
>
> MB
>
> Try this link:
>
> http://216.239.53.104/search?q=cache:682PNTJDTxEJ:www.csam-asam.org/Bup%2520Clinical%2520Info/buprenorphine_approved.htm+site:csam-asam.org+Suboxone+Subutex+FDA+approved+two+forms&hl=en&ie=UTF-8
>
>
Posted by Lindsay Rae on February 16, 2004, at 21:58:06
In reply to Re: Buprenorphine side affects, posted by Lindsay Rae on February 16, 2004, at 17:06:07
So, according to the link you provided and the knowledge that you have to suffer horrible pain to switch from being comfortable on Methadone to Suboxone, it seems virtually impossible to make the switch. The only reason I want to switch is because of the weight gain that has plagued me for the past two years. I'm gaining weight, and I'm literally starving. And constipated.
Anyhoo, what I mean is, it seems to me that the Methadone advocate groups are happy with the FDA decision to classify Buprenorphine, both as Subutex and Suboxone, as a Schedule III med, when in reality, Suboxone should be a Schedule IV since there is virtually no abuse potential. It could be because they are trying to keep Methadone from becoming obsolete. On the other hand, the president of the American Society of Addiction Maintenance feels differently, like the two should be in separate categories so it would be that much easier to prescribe Suboxone.
At 120 mg of Methadone, and two years behind me (the first year at 75 mg), is there no smooth transition from the Methadone to Bup? Perhaps in cases like this, they wouldn't make me take the one that contains Naltrexone/Narcan. Does anyone know, does Subutex, without an antagonist, have the same negative effect on a stable, maintained person? Or is that a safe switch to make?
Confused in Florida,
Lindsay Rae
Posted by drrisin06 on April 27, 2004, at 16:00:48
In reply to Re: Buprenorphine side affects, posted by Lindsay Rae on February 16, 2004, at 21:58:06
> So, according to the link you provided and the knowledge that you have to suffer horrible pain to switch from being comfortable on Methadone to Suboxone, it seems virtually impossible to make the switch. The only reason I want to switch is because of the weight gain that has plagued me for the past two years. I'm gaining weight, and I'm literally starving. And constipated.
>
> Anyhoo, what I mean is, it seems to me that the Methadone advocate groups are happy with the FDA decision to classify Buprenorphine, both as Subutex and Suboxone, as a Schedule III med, when in reality, Suboxone should be a Schedule IV since there is virtually no abuse potential. It could be because they are trying to keep Methadone from becoming obsolete. On the other hand, the president of the American Society of Addiction Maintenance feels differently, like the two should be in separate categories so it would be that much easier to prescribe Suboxone.
>
> At 120 mg of Methadone, and two years behind me (the first year at 75 mg), is there no smooth transition from the Methadone to Bup? Perhaps in cases like this, they wouldn't make me take the one that contains Naltrexone/Narcan. Does anyone know, does Subutex, without an antagonist, have the same negative effect on a stable, maintained person? Or is that a safe switch to make?
>
> Confused in Florida,
>
> Lindsay RaeHI, bAck in '94 I was involved in a bup treatment-study @ a University. This was before they combined bupe with naltrexone. Part ,actually one part of the study was to determin if this was possible. I saw a flyer about the program,and instead of having to pay,they paid you in gift certificates on a clean-time basis. It was actually a pretty good program. The dose was blind,sometimes they'd give us a double dose,and you were set for 2 days. If you came up dirty for opiates they gave u half a dose. I was in the "coming off dope mode of course" so the bupe gave a mild opiate glow, put it this way, I'd leave there w/ a smile,though it was comparible to an airplane that never actually took off, fealt like the engines were reving but it never
took off.
So the program was, they played w/ your dose
,combined w/ activities&therapy(skiing,movies-restaraunts) and they took you off gradually so
I wasn't leaving w/ a smile. When the dose was so mynute the next step was taking the "naltrexone challenge" I didnt make it to this part, but they administered the naltrex, the patient would go through 3 hours of withdrawls so every opiate was flushed out of the brain,than they continued to pay you as long as you stayed on the naltrexone.
I relapsed coming off the bupe wasn't ready--however That program is still there,though im sure its changed,since they combined the bupe and the naltrexone.
So yes it is possible to get just buprenorphine.
I do beleive. I'm not sure where other than
places I've seen on the net/
I am very much wanting to switch from methadone to Bupe as well, down to 100 mgs' from 280mgs
I was at a way too ridiculously high dose.
I've heard 40mg is an ok tranfer point from done to bupe?
Be so nice to be not enslaved to a clinic.
Posted by Lindsay Rae on May 1, 2004, at 22:52:12
In reply to Re: Buprenorphine side affects, posted by drrisin06 on April 27, 2004, at 16:00:48
Hey there--
I hear what you're saying, and congrats on reducing your dose. The 40 mg dose is a general amount they use to convert you from one to the other. But in my opinion, it's BS. The only form of Bup allowed thus far is the Suboxone, and the antagonist isn't even really the problem. The problem is that, while Methadone is a full agonist, Bup is only a partial agonist. There's no easy explaination for this, but a decent comparison would be, imagine the Methadone opening the door to the receptor all the way, while the Bup only opens it partially.I don't know if that makes any sense, but I think you answered > HI, bAck in '94 I was involved in a bup treatment-study @ a University. This was before they combined bupe with naltrexone. Part ,actually one part of the study was to determin if this was possible. I saw a flyer about the program,and instead of having to pay,they paid you in gift certificates on a clean-time basis. It was actually a pretty good program. The dose was blind,sometimes they'd give us a double dose,and you were set for 2 days. If you came up dirty for opiates they gave u half a dose. I was in the "coming off dope mode of course" so the bupe gave a mild opiate glow, put it this way, I'd leave there w/ a smile,though it was comparible to an airplane that never actually took off, fealt like the engines were reving but it never
> took off.
> So the program was, they played w/ your dose
> ,combined w/ activities&therapy(skiing,movies-restaraunts) and they took you off gradually so
> I wasn't leaving w/ a smile. When the dose was so mynute the next step was taking the "naltrexone challenge" I didnt make it to this part, but they administered the naltrex, the patient would go through 3 hours of withdrawls so every opiate was flushed out of the brain,than they continued to pay you as long as you stayed on the naltrexone.
> I relapsed coming off the bupe wasn't ready--however That program is still there,though im sure its changed,since they combined the bupe and the naltrexone.
> So yes it is possible to get just buprenorphine.
> I do beleive. I'm not sure where other than
> places I've seen on the net/
> I am very much wanting to switch from methadone to Bupe as well, down to 100 mgs' from 280mgs
> I was at a way too ridiculously high dose.
> I've heard 40mg is an ok tranfer point from done to bupe?
> Be so nice to be not enslaved to a clinic.
Posted by drrisin06 on May 2, 2004, at 10:03:50
In reply to Re: Buprenorphine side affects » drrisin06, posted by Lindsay Rae on May 1, 2004, at 22:52:12
yes. that makes sense, I also read dr. bobs explanation of the partial agonist beeing the door open half way, but I though that was because suboxone is partial agonist and antagononist. Bup isnt as strong as methadone, but I know alot of x-heroin users, when facing withdrawl and transferred onto buprenorphine were fine -not sick.
I think If the methadone patient gets to a low enough dose that when they switch say to suboxone, for the first few days they may feel some wd's, because of the antagonist properties, its in effect cleaning their system of the opiate they transferred from while replacing it with the less potent buprenorphine. If annyone needs
just buprenorphine, I know of a few pharmacies that will ship this.
Its ironic beeing I got on methadone to flee heroin withdrawls and have a more smooth life, but I would rather come off heroin any day than methadone. With benzodiazipines and good sleep medication, perhaps some clonidine durring the intense w/d period I can do the 72 hours of H wd.
I had none of these things when coming off before hence one of the reasons I got On methadone.I am troubled about the same day detox,not only is it dangerous, but for methadone patients which withdrawls can last for months, this doesnt seem like it would work as wll as the detox programs say. Most admin naltrexone while unconsious, the body still goes through withdrawls and I beleive you feel alot more than the heads of these programs say. especially when they discharge you right after the procedure.
I've seen some places do it better and give u more time and meds to recover, perhaps dr bob has some knowledge on this,.wouldnt it be a shock for your heart to go into immediate withdrawl, unconcious or not.
rising
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